Name *

First Name

Last Name

Contact Number *

(###)

###

####

Deliver To (Address) *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Order Delivery Date *

MM

DD

YYYY

Order Delivery Time *

For seconds box please use "00". Thank you.

Hour

Minute

Second

AM PM

Select One *

Please indicate which family platter, if any.

Hibachi Duo Platter (4-6 PPL)

Hibachi Duo Platter (7-10 PPL)

Hibachi Trio Platter (4-6 PPL)

Hibachi Trio Platter (7-10 PPL)

None of the above

Select One *

Please indicate which family platter, if any.

Hibachi Duo Platter (4-6 PPL)

Hibachi Duo Platter (7-10 PPL)

Hibachi Trio Platter (4-6 PPL)

Hibachi Trio Platter (7-10 PPL)

None of the above

Select One *

Please indicate which family platter, if any.

Hibachi Duo Platter (4-6 PPL)

Hibachi Duo Platter (7-10 PPL)

Hibachi Trio Platter (4-6 PPL)

Hibachi Trio Platter (7-10 PPL)

None of the above

Select One *

Please indicate which family platter, if any.

Hibachi Duo Platter (4-6 PPL)

Hibachi Duo Platter (7-10 PPL)

Hibachi Trio Platter (4-6 PPL)

Hibachi Trio Platter (7-10 PPL)

None of the above

Do you want to be a Galaide Member? *

It does not apply to third-party delivery services. Free Membership

Yes, I want 15% off my bill

No, I am not interested in signing up

Is your order request correct? *

Confirm that your order request is correct by rereading the form above to avoid any errors.

Yes, Please proceed with my request to order

No, I need a representative to contact me about my order

Is your order request for delivery being made at least 24 hours before the delivery date/time? *

Orders less than 24 hours until requested delivery time should be called in and is not guaranteed. Based on availability.

Yes, my order request is being made at least 24 hours before the requested delivery date/time.

No, unfortunately, my order request is being made with less than 24 hours until the delivery date/time.